BAYFRONT ED NOVICE NURSE

INTERNSHIP PROGRAM

Author: Jennifer Sweeney, MSN, RN, St Petersburg, FLSection Editor: Faye P. Everson, RN, MSN, CEN, EMT

As more emergency departments seek to fill criticalnursing shortages with inexperienced or noviceregistered nurses (RNs), a need has developed to

better support this transition. Many emergency depart-ments rely on preceptorship programs to train noviceRNs into the ranks of critical care.1 This practice placesadditional demand on already exhausted resources. Bay-front Medical Center’s Emergency Department (St Peters-burg, FL) is feeling the full weight of this demand and iscommitted to providing a well-structured, evidence-basedsolution. Our solution is the creation of the Novice Regis-tered Nurse Internship Program.

The internship program is based on a 12-week home-study course using Sheehy’s Emergency Nursing Principlesand Practice,2 with corresponding Web-based learningmodules. Staib3 discussed several popular teaching toolsincluding simulation, concept mapping, and case studies,all of which are used in this program. Our RN preceptorsare trained in fostering clinical competence and critical-thinking skills in novice nurses with limited time andresources. RN preceptors attend a training workshop, fol-lowed by mandatory annual update classes. They arerewarded with a 1-time 4% raise on their base pay. RNpreceptors are provided with a monthly newsletter contain-ing information on a variety of topics including adult edu-cation principles, motivation, and communication. NoviceRNs accepted into the program are given full-time statusand pay upon hire.

The experience level of RN preceptors is an importantconsideration when designing the novice nurse’s orienta-tion plan. Messmer et al4 suggested that RNs identified

as experts have highly developed intuition and may nothave the ability to teach the step-by-step thinking processthat results in critical actions based on previous knowledgeor observations. Halfer5 suggested a graduated preceptor-ship in which novice RNs are first paired with competentor proficient RNs to learn prioritizing, safety, and proce-dural aspects and are then paired with an expert RN todevelop clinical sensitivity and judgment skills. This modelprovided structured experiences for the novice nurses whileeasing “preceptor fatigue.”5

Experience level is determined by the conceptual fra-mework of Benner6 regarding the characteristics of nursesfrom novice to expert practice. Novice RNs need rules toguide their actions in the absence of experience or intui-tion.7 At Bayfront, the novice RN is first paired with acompetent nurse preceptor and is then later paired withan expert. Understanding that novice RNs need time tobuild technical proficiency, before they can start processingand applying data, novice nurses spend 6 to 8 weeks in asetting where they can focus on the rules and procedureswithout the responsibility of patient assignments. Whenappropriate, supervised patient care assignments areincreased, eventually working up to a full patient loadassignment over the course of the 12- to 16-week orienta-tion period.

Frequent meetings with the Clinical Education Spe-cialist are scheduled to assess goal attainment, monitorprogress, and discuss cases to foster critical-thinkingskills, time management skills, prioritizing, and confi-dence. The Clinical Education Specialist also providesweekly “hot topics” based on the home-study modulefor the week, to highlight educational opportunitiesand stimulate conversations between the novice and thepreceptor in an effort to continue critical-thinking skillacquisition. Hot topics may be interesting articles, casestudies, newspaper clippings, or challenging questionsdeemed appropriate for fostering the novice RN’s criti-cal-thinking skills.

Finally, at the completion of the internship program,all novice RNs are enrolled in a monthly professionaldevelopment seminar for a period of 1 year. This seminaris provided in an interactive format encouraging growthand support for all new RNs at Bayfront Medical Center.

Jennifer Sweeney, Member, Manasota Chapter, is Clinical Education Specia-list, Emergency Department, Bayfront Medical Center, St Petersburg, FL.

For correspondence, write: Jennifer Sweeney, MSN, RN, Bayfront Med-ical Center, 701 Sixth St S, St Petersburg, FL 33701; E-mail: Jennifer.Sweeney@bayfront.org.

J Emerg Nurs 2010;36:173-4.

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Copyright © 2010 Emergency Nurses Association. Published by Elsevier Inc.All rights reserved.

doi: 10.1016/j.jen.2010.01.006

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Monthly topics are chosen based on literature that sup-ports novice RNs’ needs for additional support in a varietyof areas from communication skills to conflict resolution.

Because the Novice Registered Nurse Internship Pro-gram is new in its design and implementation, we have fewdata to attest to its effectiveness. We look forward to shar-ing this information as our first round of novice RNs com-plete the program and offer feedback. Bayfront is confidentthat this evidence-based practice will ultimately result inimproved recruitment, retention, and successful transitionof novice RNs into emergency nursing.

Editor’s Note: The author reports that 3 novice RNscompleted their internship program/orientation in Novem-ber 2009 and 1 more was finished in January 2010. Sheplans evaluations at 6 and 12 months to determine whetherthe goals of the program have been met.

REFERENCES1. Paton BI, Binding L. Keeping the center of nursing alive: a framework for

preceptor discernment and accountability. J Contin Educ Nurs. 2009;40(3):115-20.

2. Howard PK, Steinmann RA, editors. Sheehy’s Emergency Nursing Princi-ples and Practice. 2010. St Louis, MO: Elsevier; 2010.

3. Staib S. Teaching and measuring critical thinking. J Nurs Educ. 2003;42(11):498-508.

4. Messmer PR, Jones SG, Taylor BA. Enhancing knowledge and self-confidence of novice nurses: the “Shadow-a-nurse” ICU program. NursEduc Perspect. 2004;25(3):131-7.

5. Halfer D. A magnetic strategy for new graduate nurses. Nurs Econ.2007;25(1):6-12.

6. Benner P. From Novice to Expert: Excellence and Power in Clinical NursingPractice. Reading, MA: Addison-Wesley; 1984.

7. Proulx DM, Bourcier BJ. Graduate nurses in the intensive care unit: anorientation model. Crit Care Nurse. 2008;29(1):20-1.

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